TY - JOUR
T1 - Multicenter analysis of geriatric fitness and real-world outcomes in older patients with classical Hodgkin lymphoma
AU - Orellana-Noia, Victor M.
AU - Isaac, Krista
AU - Malecek, Mary Kate
AU - Bartlett, Nancy L.
AU - Voorhees, Timothy J.
AU - Grover, Natalie S.
AU - Hwang, Steven R.
AU - Nora Bennani, N.
AU - Hu, Rachel
AU - Hill, Brian T.
AU - Mou, Eric
AU - Advani, Ranjana H.
AU - Carter, Jordan
AU - David, Kevin A.
AU - Ballard, Hatcher J.
AU - Svoboda, Jakub
AU - Churnetski, Michael C.
AU - Magarelli, Gabriela
AU - Feldman, Tatyana A.
AU - Cohen, Jonathon B.
AU - Evens, Andrew M.
AU - Portell, Craig A.
N1 - Publisher Copyright:
© 2021 by The American Society of Hematology.
PY - 2021/9/28
Y1 - 2021/9/28
N2 - We performed a multicenter retrospective analysis across 10 US academic medical centers to evaluate treatment patterns and outcomes in patients age $60 years with classic Hodgkin lymphoma (cHL) from 2010-2018. Among 244 eligible patients, median age was 68, 63% had advanced stage (III/IV), 96% had Eastern Cooperative Oncology Group performance status (PS) 0-2, and 12% had documented loss of $1 activity of daily living (ADL). Medical comorbidities were assessed by the Cumulative Illness Rating Scale–Geriatric (CIRS-G), where n 5 44 (18%) had total scores $10. Using multivariable Cox models, only ADL loss predicted shorter progression-free (PFS; hazard ratio [HR] 2.13, P 5 .007) and overall survival (OS; HR 2.52, P 5 .02). Most patients (n 5 203, 83%) received conventional chemotherapy regimens, including doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD; 56%), AVD (14%), and AVD with brentuximab vedotin (BV; 9%). Compared to alternative therapies, conventional regimens significantly improved PFS (HR 0.46, P 5 .0007) and OS (HR 0.31, P 5 .0003). Survival was similar following conventional chemotherapy in those ages 60-69 vs $70: PFS HR 0.88, P 5 .63; OS HR 0.73, P 5 .55. Early treatment discontinuation due to toxicity was more common with CIRS-G $10 (28% vs 12%, P 5 .016) or documented geriatric syndrome (28% vs 13%, P 5 .02). A competing risk analysis demonstrated improved disease-related survival with conventional therapy (HR 0.29, P 5 .02) and higher mortality from causes other than disease or treatment with high CIRS-G or geriatric syndromes. This study suggests conventional chemotherapy regimens remain a standard of care in fit older patients with cHL, and highlights the importance of geriatric assessments in defining fitness for cHL therapy going forward.
AB - We performed a multicenter retrospective analysis across 10 US academic medical centers to evaluate treatment patterns and outcomes in patients age $60 years with classic Hodgkin lymphoma (cHL) from 2010-2018. Among 244 eligible patients, median age was 68, 63% had advanced stage (III/IV), 96% had Eastern Cooperative Oncology Group performance status (PS) 0-2, and 12% had documented loss of $1 activity of daily living (ADL). Medical comorbidities were assessed by the Cumulative Illness Rating Scale–Geriatric (CIRS-G), where n 5 44 (18%) had total scores $10. Using multivariable Cox models, only ADL loss predicted shorter progression-free (PFS; hazard ratio [HR] 2.13, P 5 .007) and overall survival (OS; HR 2.52, P 5 .02). Most patients (n 5 203, 83%) received conventional chemotherapy regimens, including doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD; 56%), AVD (14%), and AVD with brentuximab vedotin (BV; 9%). Compared to alternative therapies, conventional regimens significantly improved PFS (HR 0.46, P 5 .0007) and OS (HR 0.31, P 5 .0003). Survival was similar following conventional chemotherapy in those ages 60-69 vs $70: PFS HR 0.88, P 5 .63; OS HR 0.73, P 5 .55. Early treatment discontinuation due to toxicity was more common with CIRS-G $10 (28% vs 12%, P 5 .016) or documented geriatric syndrome (28% vs 13%, P 5 .02). A competing risk analysis demonstrated improved disease-related survival with conventional therapy (HR 0.29, P 5 .02) and higher mortality from causes other than disease or treatment with high CIRS-G or geriatric syndromes. This study suggests conventional chemotherapy regimens remain a standard of care in fit older patients with cHL, and highlights the importance of geriatric assessments in defining fitness for cHL therapy going forward.
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U2 - 10.1182/bloodadvances.2021004645
DO - 10.1182/bloodadvances.2021004645
M3 - Article
C2 - 34448831
AN - SCOPUS:85116147941
SN - 2473-9529
VL - 5
SP - 2623
EP - 3632
JO - Blood Advances
JF - Blood Advances
IS - 18
ER -